What causes headaches? What are the most effective treatments? An expert in the field answers your most common questions, including how to prevent headaches...

Headaches are some of the most common medical conditions yet also the most complex.

“There’s not just one answer as to why people get headaches or what you can do to treat and prevent them,” says Janine Good, M.D., associate professor of neurology at the University of Maryland School of Medicine and medical director of ambulatory services at the University of Maryland Medical Center, in Baltimore.

“A headache can range from an hour of discomfort brought on from squinting at your computer screen to an indication of a life-threatening illness,” Dr. Good says.

The two basic headache types are primary and secondary.

Primary headaches, which include tension headaches, cluster headaches and migraines, may be miserable but they are not life-threatening.

“Tension headaches are by far the most common kind,” Dr. Good says. “Most people can treat them successfully with over-the-counter medication. But even a mild tension headache can become problematic if you have them often and are taking OTC pain medication more than three times a week.”

Secondary headaches are either a symptom or result of a medical condition, anything from the flu to a brain tumor.

Ironically, over-treating headaches actually leads to more of them.

“People who use medication too frequently are setting themselves up for rebound headaches,” she says.

“They’re waking up in the morning with a dull ache in their head, much like a hangover.”

Lifescript sat down with Dr. Good in an exclusive interview to discuss how to break the headache cycle — or better yet, how to prevent headaches altogether.

What causes headaches?
Caffeine overuse and withdrawal is a major source of headaches for people in America.

Our bodies become accustomed to large amounts of caffeine and then, perhaps if we’re on vacation and don’t get up and have our usual cup of coffee at the usual time, we’ll awaken with a headache.

Hormonal changes are a common culprit – if a woman goes on the pill or hormone replacement, she’s at increased risk for headaches.

A lot of women get headaches during perimenopause, even those who previously didn’t suffer with them.

Overuse of OTC medicines can cause headaches. And sleep apnea or teeth grinding lead to headaches.

What about food triggers?The classic three that bother a lot of people are hot dogs, aged cheese and red wine.

But some people have trouble with foods you wouldn’t expect, such as citrus fruits or orange juice.

Yogurt and other dairy products trigger some people.

What are some misconceptions?People believe that high blood pressure gives them a headache, but actually that’s uncommon. Your blood pressure has to be extremely high to trigger a headache. A slight elevation won’t do it.

People also often say, “It’s just a sinus headache.” But minor allergies and sinus irritation alone aren’t enough to cause a headache.

It has to be a severe sinus infection with congestion, swelling and pus.

A lot of people are convinced they have seasonal or allergy-related headaches.They might be sensitive to changes in barometric pressure.

Some people can feel a storm front or snow coming and for others, heat and humidity can trigger a headache.

Exactly what sets off the headache varies a great deal across individuals. You can’t make a blanket statement such as: “People get more headaches in the winter.”

Are certain people just prone to headaches? Why do some people get them all the time and others not at all?
There seems to be a genetic predisposition to headaches, but we don’t understand the exact link. One in six people with migraines, for example, has a first-degree relative with migraines.

The question is, “What is the common neurotransmitter for headaches?” We haven’t isolated it yet.

What are the types of headaches?Primary headaches include tension headaches, migraine and cluster headaches.

They are called primary because they’re conditions unto themselves, not connected to another medical problem.

Secondary headaches are caused by another condition. More than 50 diseases can cause headaches.

Let’s go through the types. What are the causes, symptom and treatments of tension headaches?Tension headaches tend to be bilateral, which means both sides of the head hurt equally.

It’s a dull pain, not throbbing, and pain is the only symptom. Just as the name implies, these headaches are often caused by muscle tension, or perhaps stress or behaviors such as bad posture or even teeth clenching.

They can usually be managed at home with over-the-counter medication.

What about migraines?Migraines are usually, but not always, focused on one side of the head, often accompanied by symptoms such as nausea, and light and noise sensitivity.

The pain is more severe and long-lasting, often requiring prescription medication to handle it.

Most migraines last between 4 and 72 hours.

Migraine sufferers just want to lie down in a dark room. They don’t want to move or be spoken to; they can’t eat or talk.

Women get migraines more frequently than men.

And cluster headaches?Cluster headaches peak very quickly and don’t last long – anywhere from 15 to 90 minutes. They often reappear, so a person might have several in a row.

During the headache, there are often other symptoms, usually focused around the eye or front of the face, such as tearing of the eye, running in one nostril, lid droopiness, or sweating on one side of the face.

Cluster headaches are often described as “head-banging” headaches because patients become very agitated, like they want to bang their heads against the wall.

Someone with a cluster headache may be pacing or tapping his foot, so distraught that he may describe himself as suicidal. It’s the opposite of the behavior of a migraine sufferer, where the person just wants to curl up and be left alone.

Middle-aged men are most likely to get cluster headaches. Smoking puts you at increased risk.

What are some medical conditions that can cause a secondary headache?Anything viral — the flu, or a cold. More serious conditions are an infection in the brain, meningitis, aneurysms, extremely high blood pressure or a tumor.

What can we do to prevent headaches?We can’t help inheriting a tendency toward headaches, but with proper lifestyle choices, we can reduce the frequency of them.

Drink lots of water. Exercise. Avoid excessive caffeine.

If you know you have dietary triggers, such as red wine, cut them out of your diet.

Alleviate tension through stress management and make sure you have proper posture, such as an ergonomically designed chair at work.

Sleep is important. Proper sleep means a routine, sleeping about the same number of hours each night and not changing that pattern by staying up late or napping on weekends.

Only use over-the-counter (OTC) medication if you really need it.

How much OTC medication is too much?Every day is definitely too much. Limit aspirin or Tylenol to no more than three days a week. Some drugs, such as Excedrin Migraine, are especially likely to set you up for the vicious cycle of rebound headaches.

If you take a medication every day, your body comes to expect it, and as the meds wear off during the night, you wake up with a low-grade dull ache often accompanied with anxiety. So you take more medication, and the cycle starts all over.

How do you know when you need to visit your doctor?If the OTC medication isn’t cutting it in terms of pain control, or if you’re using it more than two or three times a week, your headaches need medical attention. You should also see your doctor when there’s a change in the pattern, such as the headaches are progressively getting worse, or you’re developing new symptoms.

When should you go to the emergency room with a headache? In other words, what are the signs something more severe is going on?Any time you have a sudden onset headache with severe pain or symptoms that are unfamiliar to you, you should visit the emergency room. We call these “crash” headaches, and they can quickly put you at your wits’ end. You need to make sure that something more dangerous isn’t going on, and doctors will treat all such severe head pain as a secondary headache until proven otherwise.

You should also seek medical advice if you have a severe headache and are over 50, or if you have other symptoms such as numbness or dizziness. And if the headache is following an injury or blow to the head, go to the emergency room. You may need a CT scan.

How Much Do You Know About Migraine Headaches?In the U.S. alone, 30 million people suffer from migraine headaches, and the condition is three times more common in women than in men. However, surveys show that fewer than half of sufferers have received a diagnosis from their health-care providers. Do you or someone you know get migraine headaches? Test your knowledge with our migraine quiz.

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